Commencement Matters

IDA Ireland Site Visits

I dtús, ba mhaith liom fáilte a chur roimh an Aire go dtí an Teach. I welcome the Minister and thank her for her attendance.

I would like to highlight the issue of the Bose factory in Carrickmacross, which closed in May 2015 with the loss of over 150 jobs to the town of Carrickmacross. Bose had been in Carrickmacross since 1978 and was very successful there but unfortunately it has now transferred its operations to Malaysia and Mexico. Despite attempts by IDA Ireland and Enterprise Ireland to find a replacement, no new investor has been found to date. The building is now an empty shell. It is a fine facility which extends to 8,000 sq. ft. of accommodation of both office and production facilities. It has over 200 car parking spaces and it sits on a site area of approximately 7.2 acres.

Indigenous jobs have been the backbone of County Monaghan to date. That has been the history. A few companies have worldwide recognition, namely, Monaghan Mushrooms, a leading light in the production of mushrooms, and Combilift, another name that is recognised worldwide. Unfortunately, all of these companies are under severe threat aas a result of Brexit and the constant and current decline in the value of sterling. There is now extreme pressure on the local economy and local business as a result of this. If ever there was a time in Monaghan for a need to diversify employment, it is now. We are at a critical junction in our history.

An interesting statistic is that in 2014, 85% of leaving certificate students progressed to further education. That is very welcome. Unfortunately, only 24% of those graduates end up getting employment in County Monaghan. That is quite a worrying statistic. Our young people are being educated and moving on and not returning back home again. This statistic is very low by national standards.

I get no pleasure in saying the record of IDA Ireland and Enterprise Ireland in attracting business to the county in general has been very poor. An example of this is that from 2009 to the first quarter of 2016, which is a seven-year period, only four visits have occurred. Four visits in seven years is a sad indictment which is even more emphasised when one considers the location of Carrickmacross. It is less than 45 minutes from Dublin Airport and there is a motorway almost the whole way to Dublin city. It also has good transport links to Belfast. It is a great place to live and housing is very affordable. It has a lot going for it.

I plead with the Minister to redouble her efforts to encourage IDA Ireland and Enterprise Ireland to look at County Monaghan as a viable location for any industry because we are hurting. The facility has being lying idle for over a year and a half now. We are under increased pressure owing to Brexit and the pressures of the declining value of sterling. We are at a crossroads. It is critical that IDA Ireland and Enterprise Ireland refocus their efforts on trying to get replacement industry into County Monaghan in order that we can counteract the losses we have incurred and the hurt we are going through.

I again thank the Minister for her time and attention. The members of Carrickmacross-Castleblayney municipal district would be delighted to have a meeting with at her earliest convenience to try to progress this issue.

I thank the Senator for raising this Commencement matter. The Minister for Arts, Heritage, Regional, Rural and Gaeltacht Affairs, Deputy Heather Humphreys, and Senator James Reilly have also raised the issue with me.

I was very disappointed when Bose made the decision to leave Carrickmacross after spending over 37 years in County Monaghan. The impact of this closure was very difficult not only for the 140 full-time employees and their families but also for those who work seasonally at the plant and the wider community.

Following the announcement of this closure, an inter-agency co-ordination group chaired by Enterprise Ireland was established to address the needs of the affected staff. IDA Ireland was a member of this group with Monaghan County Council, the local enterprise office, the Department of Social Protection and the education and training boards of Cavan-Monaghan and Louth-Meath. The group helped to develop a demographic and skills profile of former staff at the BOSE facility. This was completed by IDA Ireland in partnership with BOSE human resources, HR, locally. This profile is central to IDA Ireland's marketing of the location to clients whose requirements it may match. Enterprise Ireland also actively markets the facility to its client base.

As Minister for Jobs, Enterprise and Innovation, I am committed to finding a new investor for the site and to bringing new employment opportunities to Carrickmacross. IDA Ireland obviously has an important role to play and know that the agency is committed to attracting new investment to the north-east region. I am in regular contact with the agency and I have directed it to ensure every effort is made to market the facility and the town to potential investors.

It remains the case, however, that the ultimate decision by companies as to where to locate in Ireland is always taken by their management. I emphasise that supporting regional job creation has been a priority of mine since my first day in office. I want to ensure regional Ireland benefits from our hard-won economic growth and that the jobs recovery is felt in every single county. As announced yesterday as part of the budget, my Department has secured funding for a number of measures that will improve regional competitiveness and help Border counties in particular to cope with the impact of Brexit.

There are other policy tools at our disposal to help regional development. For example, the north east-north west action plan for jobs launched in November last year aims to deliver 28,000 extra jobs in the north east. I have met this group. All regional action plans will also be supported by investment of up to €250 million in the next five years, including €150 million for IDA Ireland's regional property programme. In addition, IDA Ireland has committed to increasing investment by 30% to 40% in each region by 2019 as part of its strategy Winning: Foreign Direct Investment 2015-2019. The north east has many strengths, including a talented workforce, its existing cluster of companies in international business services and engineering and its proximity to Dublin Airport. I am confident, therefore, that Carrickmacross, together with the wider region, will experience increased employment and investment in the time ahead. I would be very glad to meet the Monaghan group the Senator would like me to meet.

I thank the Minister for her reply and acceding to the request to meet councillors from the Carrickmacross-Castleblayney Municipal District. I welcome the contents of her statement. The old adage that "the proof of the pudding is in the eating" springs to mind. When we turn on the radio every morning and hear about job announcements, they are normally in Cork, Dublin or Galway. Good luck to those three locations, I do not have any issues with them. However, I would love to turn on my radio some morning and hear about a jobs announcement in counties Monaghan, Cavan, Donegal or elsewhere. Until Government policy is very much pointed in that direction, I am afraid it could be some time before we hear those announcements on our radio stations.

I will give those involved the benefit of the doubt. I look forward to IDA Ireland's commitment to increase investment in the regions by 30% to 40%. When one considers the statistics I provided this morning - the fact that there have been four visits in seven years - most people would admit that one would not get too excited about a 30% or 40% increase on that figure. We live in hope. I look forward to the Government keeping a special eye on regions such as counties Monaghan and Cavan and all of the Border areas that are suffering and that will continue to suffer hardship until Brexit washes itself through. I also look forward to the Government trying to encourage IDA Ireland and Enterprise Ireland to, in turn, encourage investors to come to those locations.

I thank the Senator. I want to make it very clear that Government policy is to ensure there is regional development across the country. There is a strategic group in County Monaghan working to ensure that jobs are brought to the county and the Border area. I have met that implementation group. There are regional plans. Perhaps it would be a good idea for the Senator to get the regional plan for the area in order to ensure he knows what are the exact targets. I would be delighted to meet the group the Senator asked me to meet. I have met the county manager, the different educational people, the local enterprise offices, IDA Ireland and Enterprise representatives there. I will meet the group mentioned by the Senator. It is a targeted area and we will do everything we can to make sure that jobs come to County Monaghan.

Neuro-Rehabilitation Services

I welcome the Minister of State at the Department of Health, Deputy Finian McGrath. I also welcome the increased health spending announced in yesterday's budget, particularly provisions for home-care services and people with disabilities. With more money, the major challenge now is to ensure the announcement translates into the much-needed services and supports for people who need them. This matter relates to the 25,000 people in Ireland who are living with neurological conditions and need rehabilitation every year and their carers.

Despite spending more money than ever before on health care, there are still dire shortages in some services. I draw the Minister of State's attention to the lack of core services for people living with conditions such as stroke, acquired brain injury, multiple sclerosis and Parkinson’s disease. Every year, over 25,000 people need rehabilitation and most of them struggle to get the services they require. Many need specialist services with skilled multidisciplinary teams to support them on their rehabilitation pathway. Without access to core rehabilitation services, people are left with preventable disabilities, cannot return to work and are accommodated in nursing homes which can often be completely unsuitable for their needs.

This problem is at crisis level because services are under-developed and under-resourced. People with neurological conditions report the following problems with neuro-rehabilitation services. They include problems with availability and waiting lists, inequities in access, lack of clear pathways, lack of co-ordination and significant problems in navigating the system. It is bad enough to have been diagnosed with a stroke but the person must then try to find his or her way through a system in circumstances where he or she needs help. Other problems include lack of support and training for family members, lack of skilled neuro-rehabilitation health care professionals and failures in the Department of Health and the HSE to drive the necessary change relating to the growth and development of neuro-rehabilitation services.

Recent media coverage has highlighted these issues and how people are suffering as a result. We have heard from people waiting over two years for a place in the National Rehabilitation Hospital as well as people travelling abroad for rehabilitation and, what is worse, losing any gains when they return due to a lack of appropriate neuro-rehabilitation services in the community. Many more never got the opportunity to get the rehabilitation they needed and lost a vital window of recovery that will impact them for the rest of their lives.

The case I am about to outline is just one example.

Mr. Colm Griffin was 36 years old, healthy and fit, and a qualified engineer. As a result of corrective surgery on an aneurysm in 2015, he had a stroke. The left side of his body was affected and he could no longer walk, use his left arm or dress himself. He was unable to drive or go to work. In Cork University Hospital, he got access to physiotherapy and hydrotherapy but otherwise the facilities were very limited. In February 2016, he got a bed in the National Rehabilitation Hospital and completed 12 weeks of therapy. Although the individual therapists did their very best, his experience was one of deep frustration as there are huge limitations on the number of therapy hours there. He kept a timetable from that time and recorded an average of three hours physiotherapy over five days and just one hour of hydrotherapy. In addition, there was no access to the facilities after hours or at the weekend. Since he returned home, friends and family had to fund-raise to pay for private physiotherapy.

Ireland should have 270 inpatient beds for our population but we have less than half of that number and none outside Dublin. We should have four regional inpatient specialist rehabilitation services nationwide but we have none. There should be at a minimum nine community neuro-rehabilitation teams nationwide, one in each community health organisation as a starting point, but there are only three, and these are only partially staffed. We have the lowest number of consultants in rehabilitation medicine anywhere in Europe.

The lack of specialist and community rehabilitation services is impacting significantly on other areas of the health system, as the Minister of State knows, exacerbating the problem of delayed discharges from acute hospitals. The national policy and strategy for the provision of neuro-rehabilitation services in Ireland was published in 2011 and it is unacceptable that there has been little progress in the development of new services since its publication. A long overdue draft implementation framework for the strategy was finally released, five years later, in February 2016. The Neurological Alliance of Ireland and others have serious concerns with the draft framework which lacks dedicated funding and any timelines. It also lacks accountability and the scope required to deliver real improvements that people need. It is essential that a revised plan is put in place.

I wrote to the HSE which has stated it has long appreciated the need to review the issue. That is hardly good enough after five years. I would like specifics on what plans the Minister has in place to secure the 270 inpatient beds. When will these beds be in place? When will we have beds outside Dublin in places such as Cork? What about the four regional inpatient specialist services and when will the Minister put in place fully the nine community neuro-rehabilitation teams? We have waited a very long time and the people with the conditions are really in need and at risk. I would like some specifics and clear timetable.

I thank the Senator for raising this very important issue. As it is my first time debating with her, I welcome her to the Seanad and congratulate her on being nominated. We need voices like hers in the Seanad, particularly with respect to this morning's subject. I will respond here, but I will speak to her later about issues relating to her question. I thank the Senator for raising the matter of inpatient and community neuro-rehabilitation services and improving the patient pathway from hospital to home. I welcome the opportunity to outline the current position in that regard.

A Programme for a Partnership Government places a particular focus on a number of key programmes and strategies, including publishing a plan for advancing neuro-rehabilitation services in the community. As part of a review of how specialist rehabilitation services are accessed and provided, the HSE and the Department of Health jointly published the national policy and strategy for the provision of neuro-rehabilitation services in Ireland 2011 to 2015. In addition, the rehabilitation medicine programme was established within the clinical strategy and programmes directorate of the Health Service Executive.

With regard to the update, a steering group, led by the HSE social care division, has circulated a draft implementation framework for the national policy and strategy for neuro-rehabilitation services for consultation to members of the steering group and stakeholder agencies. This implementation framework will guide and oversee the reconfiguration and development of neuro-rehabilitation structures and services at national and local level. The framework outlines key issues, themes and considerations. It makes particular reference to the need to reconfigure and develop community services within the HSE's community health care organisations and inpatient specialist rehabilitation services. It is planned that implementation of the neuro-rehabilitation policy and strategy will involve reconfiguration and development of resources with the community health care organisations to establish specialist neuro-rehabilitation teams within each area. Second, it will involve reconfiguration and development of specialist inpatient rehabilitation services in line with the rehabilitation medicine programme model of care and national trauma policy and integration of all specialist rehabilitation services within what is envisaged to be managed clinical networks. Moreover, each of the nine community health care organisations will establish local implementation teams; a neuro-rehabilitation network, based on a hub and spoke model, will serve population-based areas of the country; and managed networks will link closely with the National Rehabilitation Hospital, community rehabilitation teams, primary care and acute hospitals in their areas.

Specialist inpatient services are concentrated at a national level in the National Rehabilitation Hospital. The hospital provides a comprehensive range of specialist rehabilitation services for adult and paediatric patients. These are patients who, as a result of accident or injury have acquired physical or cognitive disability and require specialist medical rehabilitation. Effective rehabilitation draws on a broad range of disciplines to meet the particular needs of individuals. The objective is to assist with returning to life in the community with confidence. Approximately 1,000 people are treated on an inpatient basis at the hospital each year and approximately 5,000 people are treated on an outpatient basis. Many patients have a lifelong association with the hospital.

The Government has also announced a major capital development of the National Rehabilitation Hospital. The project will deliver a 120 replacement bed ward block. It will include support therapies to paediatrics and acquired brain injury patients, a hydrotherapy unit and a sports hall. Its completion is the priority project in rehabilitation medicine. It is envisaged that the implementation of the national policy and strategy for the provision of neuro-rehabilitation services, along with the investment in the National Rehabilitation Hospital, will greatly contribute to improved care pathways for patients from home to hospital.

This is a priority service issue, on which I am working very closely with the Minister, Deputy Simon Harris. There has been talking about this for too long. We want to push on the agenda. I will respond to further questions. The Minister and I feel very strongly that we must invest in this service and do the job.

We are well over time on this matter.

As the 12 minutes are up, the Senator should be brief. The trouble arises if we allow more than 12 minutes for one topic and not another, as Members may complain.

I take the point. It is a great policy but it was meant to run to 2015 and we are now in 2016. There is an implementation plan, a framework, a steering group and reconfiguration. When will all these translate into inpatient beds and community teams, and when will the developments in the hospital be completed? Is there enough in the budget this year to do all of this? Should we see it fully implemented by the end of 2017?

We have enough in the budget, particularly with the increases in this year's budget. Our problem will be the competing elements within the budget. The Senator can take it from me that this is a priority issue. I agree with her that this must translate into action in delivering the services. We have the plans and focus; therefore, it is up to us who are in a position to push it along. I accept that services are underdeveloped and hanging around for another two years would not be acceptable. I give that commitment, but I will go back to the Minister, Deputy Simon Harris. Both of us will work on the issue. I hope to see some serious movement before Christmas. There is extra funding available.

We are all, including me, competing for different slices of the pot for disabilities. This is within that sector. I will do my best and give a commitment today, given that we need to have these services developed. These are people with major issues in their lives and we must do something about it.

I am sure the Senator will revisit it in the new year if progress is not made.

Nursing Home Accommodation Provision

I thank and welcome the Minister of State. This matter relates to a patient who has been in St. Vincent's University Hospital, Dublin, since January 2016. The advice from the medical people in May 2016 was that the appropriate facility would be Bloomfield Hospital. Bloomfield Hospital carried out an assessment and found he was a suitable patient. No decision has been taken since on the transfer. When I communicated with the HSE, its attitude was the matter was not under its jurisdiction. I contacted St. Vincent's University Hospital by telephone and correspondence and failed to receive a definitive answer as to how the issue would be resolved. The family is extremely concerned given they have been left with nothing in writing setting out exactly what will happen. This is the first time in six years that I have had to put such a matter to the Minister by way of a Commencement matter. I hope it is my last time. No family should be left waiting in this manner. That is why I am seeking the clarification.

I thank the Senator for raising the issue. He is referring to an individual who is an inpatient at St. Vincent’s University Hospital. The patient has finished his acute phase of treatment and is on the hospital’s delayed discharge list as requiring long-term residential care. Government policy is to support older people to remain in their own homes and communities for as long as possible. There will, however, always be a cohort of older people who require a long-term residential care option.

The nursing homes support scheme is a system of financial support for those assessed as needing long-term nursing home care. Anyone who is assessed as needing long-term nursing home care can avail of the scheme regardless of their age. The scheme provides financial support towards the cost of the standard components of nursing home care. Patients contribute to the cost of their care according to their means while the State pays the balance of the cost. The scheme aims to ensure long-term nursing home care is accessible and affordable for everyone and that people are cared for in the most appropriate settings.

The scheme has a net budget in 2016 of €940 million. This represents an increase of €43.1 million on the 2015 outturn. It is expected that the scheme will provide financial support to 22,989 clients on average per week in 2016. The purpose of the nursing homes support scheme is to provide a sustainable system of financial support for people in need of long-term nursing home care, which ensures such care is affordable for all who need it. Applicants are free to choose any public, voluntary or approved private nursing home in the State. The home must have availability and be able to cater for the applicant's particular needs.

On the Senator's specific query, Bloomfield Hospital is a 114-bed mental health hospital registered as an approved centre with the Mental Health Commission. The nursing homes support scheme, however, does not extend to either the disability or mental health sectors and it would contravene the statute underpinning the scheme to support a patient in this facility. The HSE is endeavouring to support the discharge of patients who have been deemed medically fit for discharge and require alternative supports, be it long-term care, home care or transitional care. The HSE has provided a list of alternative facilities that accept national nursing home scheme funding. The man was offered a place in Rathdrum public unit but it is understood this offer was not accepted. The HSE is working with the hospital social work team to find a suitable placement and the Clonskeagh community nursing unit is being considered as it has appropriate single-room accommodation and would be more accessible for the family. I hope that is the answer the Senator seeks.

The Minister of State's answer is totally unsatisfactory. The information she gave in the last part of her answer is new to me and the family. In May, the medical team in St. Vincent's University Hospital identified that Bloomfield Hospital was the appropriate place. Nothing has been given in writing since, although the family has written to the CEO of St. Vincent's University Hospital. I have written to the CEO of St. Vincent's University Hospital and have spoken to Mary McGrath, the person who deals with patient complaints. We have received nothing in writing from anybody. The answer is not adequate and I need something in writing. The person was deemed unsuitable for a nursing home facility. This was the advice the family received in May 2016 and nothing further has been given to them in writing since then. The family has been left in mid-air on the matter for the past four to five months and nobody is putting anything in writing. This is the first we have seen of this position being offered and the first time the Clonskeagh facility has been mentioned. I do not understand why something cannot be set down in writing on what is the appropriate way to deal with the matter. While the family is supportive of St. Vincent's University Hospital and whatever decision is made, nothing has been put in writing as regards best management. That is why we are concerned.

Can the Minister of State add anything? I know she is probably in a straitjacket.

I understand the frustration of the Senator and the family. It was not a waste of time for him to raise it given that we have new information. I find it surprising that nobody has received anything in writing and that this is news to the Senator and the family. When I return to my office, I will contact the relevant section and ensure there is some form of written communication, in all fairness to the family and the Senator. I thank the Senator and hope there will be a satisfactory outcome.

I received a letter from the HSE to the effect that it was not the HSE's problem and that I should deal with St. Vincent's University Hospital. I wrote to it and received no reply. That is not a way to deal with something that has been going on for four months. The HSE told me it did not know who it should contact in St. Vincent's University Hospital. It is unacceptable.

I do not think the Minister of State can resolve the matter today. Perhaps privately she might take it up to see what can be done. While I understand the Senator's frustration, we have spent as much time as possible on it.

Senator Trevor Ó Clochartaigh is next. He will be brief, as usual, and reasonable.

Community Welfare Services

Cuirim fáilte roimh an Aire. Tá mé an-bhuíoch dó as ucht an t-am a thógáil, cé go bhfuil sé an-ghnóthach ag an aimsir seo. I am returning to an issue I raised previously with the Minister's predecessor regarding the social welfare offices that were closed in rural areas and in the Connemara area in particular. As the Minister, Deputy Leo Varadkar is aware, when Deputy Joan Burton was Minister, there was a movement of community welfare officers, CWOs, from the HSE to the Department of Social Protection in 2011 and 2012, with the Department taking over more than 900 clinics that the CWOs previously undertook. The Minister at the time maintained that the service had been enhanced, with phone lines being preferable to clinics and CWOs visiting people's homes to meet them where needed. It was said that the restructuring of the services was to be done in a way that would not compromise the accessibility of the CWO and the person who succeeded them, as the job specification and the name have changed.

We had a particular concern in Connemara with the closure of the service in Carraroe and the services in Oughterard and Spiddal being rationalised and moved to Galway city. The Minister at the time told us it was to provide for a streamlined and consistent service to the customer. The language used was interesting in that it proposed a "customer" rather than a client, and that anybody using the services of a CWO or social welfare office is regarded as a customer as opposed to a client.

We were informed that where community welfare services had been restructured, alternative arrangements had been put in place to ensure "customers" - that word again - would be provided with ongoing access to the supports provided by the service and that, in general, this would mean that the frequency of available public clinics would be increased. At the time, with others, I raised issues about this because in rural areas where a service was being removed or moved to an urban centre, transport connections such as bus services were not available. The latter remains the case. For example, there is no bus service to Clifden, the nearest centre for people living in Carna, County Galway. Anyone wishing to go to the city would have to get a bus first thing in the morning, stay in the city all day and return at night. This is still the case. From places such as Carna, the bus service runs only a couple of days a week.

People have told me they have been asked to attend at the centre in Galway on several occasions for three and four days in the same week in some cases in order to finalise their claims for supports from the Department of Social Protection. It has been said that in instances where people are not in a position to travel due to a lack of resources or transport, officials from the Department would call out to them to ensure that they were provided with a service. Somebody at a briefing on the family resource centres in the audio-visual room of these Houses last week said this does not happen when a request is made.

My question relates to the closure of these offices, particularly in the context of exceptional needs payments that would have been paid over the three previous years. How much of a saving has the regional office made in exceptional needs payments to the people of Connemara since those offices were shut down? What is the level of overall savings made by the Department through the closure of those offices? Tá mé an-bhuíoch don Aire faoi theacht isteach agus tá mé ag súil go mór leis an bhfreagra a bheidh aige dom.

I thank the Senator for raising this issue of the community welfare service, CWS, in Connemara and, in particular, the closure, in September 2013, of offices in An Spidéal, An Cheathrú Rua agus Cill Chiaráin.

The Government has provided €30.3 million for the exceptional needs and urgent needs payment schemes in 2016. In line with all supplementary allowance schemes, the overall reduction in the live register and general improvement in the economy has reduced recourse to exceptional needs payments, ENPs. In 2012, 459 ENPs totalling €149,000 were paid in the three offices and 177 payments totalling €73,000 were paid up to the end of September in 2013. Corresponding details on payments since September 2013 are not available as all such payments are now included in the figures for Galway city and Clifden and are not separately identified.

In 2012 a working group made up of staff from the CWS reviewed the ENP guidelines with a view to achieving standardisation and consistency in the treatment of applications across the country. This review was used as a basis for revised guidelines that issued to staff in 2012 and 2013. These guidelines provide maximum recommended amounts for specific items such as white goods, furniture and prams. The Department reviewed these guidelines in 2015 and no changes were provided to the recommended amounts. The guidelines assist Department staff administering the scheme and do not affect the discretion available to officers in issuing a payment to assist an individual or household in any particular hardship situation which may arise. The ENP scheme is demand led and continues to provide assistance to those with exceptional needs taking into account the requirements of the legislation and all the relevant circumstances of the case in order to ensure that the payments target those most in need of assistance.

Following the transfer of the service from the Health Service Executive, HSE, to the Department in 2011, the Department has re-engineered its business model to support the provision of integrated services across all business streams involved in the delivery of localised services. As part of this strategy, the Department is engaged in the delivery of integrated Intreo centres, which provide a full range of services, including the CWS, generally available in one location. The change is a move away from the traditional model of one CWS officer serving an individual location and delivering the full range of services towards a sustainable team-based approach. Where the service has been restructured, including in the Connemara area, alternative arrangements have been put in place to ensure that customers are provided with ongoing access to the supports provided by the service.

In the Galway area, this means that the frequency of available public clinics has increased, an improved phone service and dedicated e-mail address are available and alternative arrangements are in place for those who cannot travel - for example, due to illness - including arranging a visit to the client’s home as necessary. In addition, an appointments service is now in operation which is proving very successful in terms of efficient service delivery. The community welfare clinics in An Spidéal, An Cheathrú Rua agus Cil Chiaráin all operated from premises under the remit of the HSE. The amount of money paid to the HSE for the use of their premises is included in the overall memorandum of understanding between the Department and the HSE which covers the whole country. Savings from the closure of particular clinics have not been calculated and could only be estimated on an apportionment basis. Staff who were working in these locations at the time of their closure were transferred to Galway, two remaining in the CWS and the third transferring to employment services as a case officer in the integrated Intreo service. As a result, there were no staff-cost savings.

I am very conscious of the need to provide efficient and effective customer-facing services at a local level for all customers of the Department and would like to reassure the Senator that the changes to the services in Connemara were not undertaken as a cost-saving measure but instead were intended to enhance the integration of all of the Department’s localised services in County Galway. I am not entirely sure what the Senator meant by making a distinction between customers and clients, but I would be interested to understand it.

Ní dóigh liom go bhfuil tú ró-shásta.

Nach maith é go bhfuil a fhios agat. I suppose using the frame of a business model in respect of people engaged in employment services indicates the language that a client of a State agency now becomes a customer of the State agency. My concern is the use of that language. I am unhappy with the cutbacks that have happened in the ENP because even with the figures available from 2012 to 2013 it is quite clear they were cut back to a third of what they had been the previous year. I would guess that if the figures were available, we would see an even bigger cutback.

One of the issues was the closure of the offices in rural areas. People looking for an ENP cannot afford to go to an office in the city. They feel compelled to travel into the city to go to the Intreo offices and in many cases feel intimidated in there. I know the Minister is a great proponent of the Irish language but many of these feel that the service is not being made available through Irish, for which they have to make a special effort to ask. It is very unfortunate that, according to the figures available, there has been such a huge reduction in the number of ENPs paid. Now that we are told the economy is improving, would the Minister reconsider reopening an office in the Connemara area to make it easier for those clients to access the Department's services for ENPs and other matters?

I take the Senator's point about customers and clients. To me, a customer is somebody who goes into a business and probably pays money whereas this situation is the reverse. Health care always disliked the move away from the term "patient" to those of "client" or "customer". It is the term the Department uses and it is not trying to disparage those who rely on our services but to ingrain the idea of a business model in the operations of the Department. Perhaps it is not the right language.

I visited the Intreo centre in Galway city a couple of weeks ago. It is a very impressive building and a very modern centre. I met some of the community welfare officers, including the lady who goes out to the clinic in Kilronan on Inis Mór, on the Aran Islands, and chatted with them about this issue. They are very much of the view that they can provide the service in Galway city over the telephone or by making house calls if needs be. For that reason, there are no proposals to open new offices anywhere in the country.

The overall cost of ENPs has gone down across the country for two reasons: first, fewer people have recourse to these payments because fewer are unemployed and incomes are rising again; and, second, payments were standardised across the country. On the latter point, in the past, because these payments came from the old health board system, people in different parts of the country were receiving different amounts in respect of the same fridges, microwaves or whatever they needed. There were significant savings when ENPs were standardised.

Sitting suspended at 11.20 a.m. and resumed at 11.30 a.m.